Typhus - Symptoms

Epidemic typhus has an incubation period that lasts from 5 to 25, most often 10-14 days.

Epidemic typhus occurs cyclically:

• initial period - the first 4-5 days (from the rise in temperature to the appearance of a rash);
• peak period - 4-8 days (from the appearance of the rash until the end of the feverish state);
• recovery period - from the day the temperature returns to normal until all symptoms of epidemic typhus disappear.

Symptoms of epidemic typhus in the initial period

Prodromal symptoms of epidemic typhus are usually absent, sometimes at the end of the incubation period of typhus a mild headache, body aches, chills occur. Epidemic typhus begins acutely - progressively increasing symptoms of intoxication (headache, weakness, muscle pain, dry mouth, thirst, loss of appetite, dizziness). After 2-4 days, constant diffuse headache becomes unbearable, intensifying with a change in body position, talking, the slightest movement. Repeated vomiting is possible.

Body temperature reaches its maximum (38.5-40.5 °C and higher) by the 2nd-3rd day of illness. The increase in temperature is constant, less often remittent (with short-term "bursts" on the 4th, 8th and 12th day of illness).

Patients suffer from a kind of insomnia: at first they fall asleep, but often wake up from frightening, unpleasant dreams. During this period, typical symptoms of epidemic typhus are recorded: muscle and joint pain, irritability, anxiety, euphoria, excitement or inhibition.

The appearance of patients is characteristic: the face is hyperemic, puffy, the eyes are red ("rabbit-like") due to injection of the scleral vessels. Moderate cyanosis of the lips, hyperemia of the skin of the neck and upper chest are noted. The skin is dry to the touch, hot.

The tongue is dry, not thickened, coated with a white coating. From the 3rd day of the disease, spots can be observed, the Chiari-Avtsyn symptom - point hemorrhages in the transitional folds of the conjunctiva, enanthem on the soft palate (Rosenberg symptom). positive symptoms of pinching and tourniquet, which precede the appearance of exanthema.

Moderate tachycardia and muffled heart sounds, hypotension, moderate dyspnea are characteristic. From the 3rd-4th day, an enlargement of the liver and spleen is noted.

A day before the rash appears, there may be a “cut” in the temperature curve.

Symptoms of epidemic typhus during the peak period

On the 4th-6th day of the disease, a profuse polymorphic roseola-petechial rash appears. The first elements are located behind the ears, on the lateral surfaces of the neck, with subsequent spread to the skin of the lateral surfaces of the body, chest, abdomen, flexor surfaces of the arms and inner surfaces of the thighs. On the face, palms and soles, the rash is very rare. The size of the elements usually does not exceed 3-5 mm. Epidemic typhus is characterized by polymorphism of the rash. A distinction is made between roseola, roseola with secondary petechiae, and, less often, primary petechiae. As a rule, there are no rashes. The appearance of new petechiae is a poor prognostic sign. Roseola disappears without a trace in 2-4 days, and petechiae - in 7-8 days, leaving a brown pigmentation ("unclean skin").

The overwhelming majority of patients have relative and absolute tachycardia, a pulse of weak filling and tension. The borders of the heart are dilated, the tones are muffled. Systolic murmur at the apex is often heard. Arterial pressure, especially diastolic, falls, which is associated with the vasodilating effect of the rickettsia toxin, inhibition of the vasomotor center, sympathetic nervous system and adrenal glands.

Shortness of breath often occurs. At the height of the disease, tracheobronchitis and focal pneumonia are detected. The tongue is dry, coated with a thick gray-dirty coating, can take on a brown color, often deep cracks appear. Most patients note a significant deterioration in appetite, thirst, stool retention and flatulence. Diuresis is reduced, but simultaneously with "temperature crises" it is possible to increase it. Some patients note paradoxical ischuria, when with an overfilled bladder, urination occurs in drops.

In addition to headaches and insomnia, nervous system damage is manifested by changes in the patient's behavior. Typical symptoms of epidemic typhus for this period are motor restlessness, followed by adynamia, rapid exhaustion, euphoria, fussiness, talkativeness, irritability, and sometimes tearfulness. Delirium is possible, accompanied by hallucinations of a frightening nature. Mental disorders occur in severe cases of the disease with manifestations of encephalitis.

Other symptoms typical of typhus are also associated with damage to the central nervous system: amimia or hypomimia, unilateral or bilateral smoothing of the nasolabial fold, muscle tremor, Govorov-Godelier symptom, dysarthria, dysphagia, nystagmus, hearing loss, skin hyperesthesia, meningeal symptoms. In severe cases, against the background of high body temperature, some patients experience impaired consciousness, speech becomes incoherent, behavior is unmotivated (status typhosus).

In some cases, examination of cerebrospinal fluid indicates serous meningitis (slight increase in protein content, moderate lymphocytic pleocytosis) or meningism (no abnormalities are detected in the cerebrospinal fluid).

There are no characteristic changes in the hemogram. There is thrombocytopenia, moderate leukocytosis, neutrophilic reaction, often with a band shift, eosinopenia, lymphopenia, moderate increase in ESR.

Symptoms of epidemic typhus during the recovery period

The first sign of recovery is the normalization of temperature, caused by a decrease in intoxication. At the same time, the severity of typhoid status (enlightenment of consciousness) and signs of delirium decrease. On the 3rd-5th day after the temperature decreases, the pulse and breathing rate are restored, blood pressure, liver and spleen sizes are normalized. All clinical symptoms of epidemic typhus gradually fade away.

On the 12th day of apyrexia, if there are no complications, the patient can be discharged. Full recovery occurs approximately one month after the temperature has returned to normal. Typical weakness persists for 2-3 months.

Complications of epidemic typhus

Epidemic typhus may be complicated by conditions associated with vascular damage characteristic of typhus and caused by a secondary bacterial infection.

The first group includes collapse, thrombosis, thromboembolism, thrombophlebitis, endarteritis, ruptures of cerebral vessels, damage to the nuclei of cranial nerves, polyradiculoneuritis, intestinal bleeding, myocarditis, infarction, psychosis of the convalescence period and later ones. As a result of vascular damage, bedsores and gangrene of the distal extremities occur. Critical conditions can be caused by infectious toxic shock, pulmonary embolism.

The second group of complications of typhus includes secondary pneumonia, otitis, mumps, abscesses, furunculosis, pyelitis, pyelocystitis, stomatitis, and phlegmon of the subcutaneous tissue.

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